Patellar tendinopathy is characterised by pain below the knee cap that most commonly affects people between the ages of 15 and 30 years old. It is also linked with people who take part in sports involving a high degree of jumping, hence its more common name of jumper’s knee.
Tendons are structures that attach muscles to bones. The patellar tendon connects the knee cap (patella) to the top of the shin bone (tibia).
Tendinopathy is a term that relates to disease of a tendon. You may know this as ‘tendinitis’ however this term is less commonly used now due to research showing there is not as much inflammation as previously thought.
Tendinopathy is thought to be caused by sudden or gradual overload of a tendon. This might be due to carrying out an activity that the tendon is not used to doing or gradually overloading the tendon over a long period of time. This is likely to cause structural changes to the tendon over time that may lead to ongoing pain.
Pain felt below the knee cap at the front of the knee during or after prolonged periods of sitting, squatting, jumping or using stairs.
It can be sharp and very specific at the start of the disease and then change to a dull generalised ache around the knee as time goes on.
To help your tendon recover from a sudden onset of pain it is useful to rest your knee from painful activities to begin with. This should allow natural healing processes to happen.
It is important to not rest your knee completely but more adapt what you do and how you move to reduce painful loading while it heals. For example:
The longer you rest from activities the muscles around your affected knee may lose strength so these modified movements should only be used in the short term before trying to move normally.
Over the counter painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. A short course of anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist or GP, especially if you have any underlying health conditions.
https://www.nhs.uk/medicines/paracetamol-for-adults/
https://www.nhs.uk/medicines/ibuprofen-for-adults/
Some people find using ice helpful on the painful area.
For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to three times a day.
You should be cautious using these treatments if you have altered skin sensation or circulatory problems. Check the skin regularly during and after the ice pack application. Stop if there is excessive pain, numbness or tingling. Do not put ice directly on to the skin as this may cause a burn.
There are a range of exercises to help manage this condition. In the early stages of patella tendinopathy performing exercises where you tense your thigh muscles but not actually move your leg (isometric) can be useful at maintaining strength.
See below for progressed exercises:
These exercises will help to maintain the strength and condition of your thigh muscle that the patellar tendon attaches to. It is recommended carrying out these exercises 2-3 times per day. It’s advised that your knee pain should not be higher than 4/10 on a numerical pain rating scale.
Lying flat or sitting up with your leg straight in front of you, squash the back of the knee down into the floor or sofa. Hold 5 seconds. Repeat 10 times.
Lying flat or sitting with your leg straight in front of you. Squeeze your thigh muscle to lift the leg off the floor, keeping it straight as you do this. Repeat 10 times.
Lie with knees bent and feet flat on floor or bed. Squeeze your bottom muscles and lift hips of the floor/bed. Try not to arch your back. Hold for 5 seconds then relax to start position. Repeat 10 times.
Once the basic exercises become easier and less painful to perform it is a good time to increase the loading on your tendon and build strength. This will help your tendon recover further and reduce the likelihood of the condition returning again.
Because these exercises are more strenuous, it is recommended only carrying them out once every other day. A rough guide would be to perform 8-12 repetitions of each exercise and 2-4 sets of these repetitions. Allowing a break of 30 seconds to 1 minute between sets is advisable. Pain can help guide numbers of repetitions and sets.
Sitting in a chair, bend and straighten your knee whilst keeping your thigh muscle tense as your straighten and bend.
Sit on the edge of the chair and without using your hands, push with your leg to stand up, slowly lower your bottom back to the seat.
Stand on step and then step off with unaffected leg first in slow, controlled manner.